Noninvasive evaluation of cardiotoxicity of 5-fluorouracil and low doses of folinic acid: A one-year follow-up study

Summary Purpose: To conduct a serial evaluation of the cardiac effects of antineoplastic therapy with 5-fiuorouracil (5-FU) and lowdose folinic acid. Patients and methods: Sixteen patients with colon-rectal carcinoma, without cardiac disease, treated with 400 mg/ m2/dic of 5-FU and 20 mg/m2/die of folinic acid for five days, once a month, for six months. Parameters evaluated: blood pressure, ECG, two-dimensional and digitized M-mode echocardiograms before and after the first and fifth drug administrations of the first cycle, after the fifth drug administration of the second cycle, after the fifth drug administration of the sixth cycle and six months after the treatment. Results: Blood pressure, heart rate, left ventricular (LV) diameter and LV mass index did not change; all of the patients showed a decrease in the peak shortening rate of the LV diameter, index of systolic function, and of the peak lengthening rate of the LV diameter and peak thinning rate of LV posterior wall, indexes of diastolic function, with abnormal values in 11 patients at the end of treatment. LV wall motion remained normal in all; two patients developed transient T wave inversion without chest pain and with normal cardiac enzymes and myocardial scintigraphy during dypiridamole stress test. Six months after the treatment all indexes of LV systolic and diastolic function had returned within the normal limits and were similar to pre-treatment values. Conclusions: 5-FU and low-dose folinic acid treatment induced a decrease of LV systolic function and an impairment of diastolic function, that developed without symptoms and were transient and reversible.